Policy Proposal to USAID - Research Paper Example

Policy Proposal to USAID Introduction HIV stands for Human Immunodeficiency Virus. HIV is the virus that causes AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the most advanced stage of HIV infection.  When the cost of treatment is pegged at $15,000 per person per year, and the per capita expenditure on health works out to US $ 38, it is obvious that cure is very difficult in spite of the efforts of the developed nations and UN, and prevention holds the key for solution in the long term.  CRS issue of brief for US Congress (2003) states, ‘Treatment cost over $15,000 per person per year until activists and developing country pharmaceutical companies forced the big companies to reduce prices to as low as $350 per person per year’ Even if the prices are reduced as desired, the disparity is huge, that accounts for the failure of the well intended programs.  African countries are the worst affected due to HIV/AIDS.  Angola assumes significance on account of 27years of civil war, and the consequential refugee problem. ‘Despite the efforts being made, it will take many years before recovery activities can come to an end. Angola ranks 143 out of 182 countries in the 2009 Human Development Index with 70 percent of its population living on less than US$2 per day. Many communities have little or no access to basic social services, while more than a third of children are not enrolled in school’. (World Food Programme 2009)       USAID in Angola USAID activities in Angola are mainly aimed at Macro economic environment, and have ten public-private partnerships that co-fund USAID activities. This policy proposal envisages, comprehensive project for prevention of HIV/AIDS in Anglola, considering the lethal implications of HIV/AIDS to the society and future generations.           Executive Summary Eradication of HIV/AIDS covers prevention and cure.  In view of the enormity of the problem and the financial constraints, we have to follow a balanced approach keeping in view the positive impact of prevention on future generations.  However, the project we propose as well as the governments and the international bodies should aggressively take measures and come to the rescue of the victims of the disease as well as prevention. ‘An estimated 22.4 million adults and children were living with HIV in sub-Saharan Africa at the end of 2008. During that year, an estimated 1.4 million Africans died from AIDS. Around 14.1 million children have lost one or both parents to the epidemic. (Sub Saharan Africa HIV and AIDS Statistics - Table I in Appendices.) Therefore, a comprehensive strategy for the prevention and cure, with reference to the HIV/AIDS, has to be evolved with the objectives precisely enunciated, considering the various options and constraints involved in the implementation of the program, and the study attempts to achieve this purpose, in relation to the institution which has sound and balanced background with great tradition       Policy Proposal & Options  Policy proposals and options are to a larger extent depending upon the nature of services to be undertaken, the cost of implementation, staffing requirement, financial constraints, the support services and the infrastructural facilities available, coordination of the international bodies such as World Health Organization, United Nations Development Program, etc. We can also observe involvement of corporate bodies and international financial institutions in this mission, since the future of the existing projects and the projects under construction in these parts of the world are dependant upon the overall social and economic conditions of the respective countries.            For example, Hopps (2009) explaines ‘IFC is stepping up its fight against HIV/AIDS with plans to increase the number of company prevention, education and care programs it supports across sub-Saharan Africa…  A vital plank in IFC’s overall strategy of reducing poverty and improving lives, IFC Against AIDS helps large corporations develop health and support strategies for their employees, accelerating the involvement of the private sector in managing the disease.’           Similarly,  SOS Children is working in Benguela and Lubango, two towns in south-western Angola, and is reaching out to AIDS orphans and other vulnerable children and their families in the local communities..  Other smaller charities have also presence in Angola. Private companies’ efforts are also worth mentioning. ‘Odebrecht, a Brazilian construction company with operations in Angola, has earmarked $1 million of a $280 million IFC corporate loan for efforts to fight AIDS. United Nations Development Program: ‘UNDP is concentrating mainly on Strengthening the Education System in Angola to Combat HIV/AIDS. HIV/AIDS’. Funding of the Project  After the civil war, various programs related to the country gathered momentum which would ensure developments in the society, consequently stability of the governments in the region.  In order to reap the full benefits in the long run, in view of the size of the project under proposal, it is advisable to finance the scheme with novel and progressive strategies involving corporate bodies of the developed countries.  The success of the program hinges on the following factors:  1. Long term and regular availability of funds for the project. 2. Long term and regular availability of the medicines for the HIV/AIDS patients. 3. Effective distribution of medicines. 4. Periodical medical checkup 5. Active cooperation and coordination of the government and the other international agencies and charitable organizations. 6. Creation of awareness among the public through education and training. 7. Regulations through proper legislations. Program goals  The goals are defined with reference to eradication of HIV/AIDS taking into account, strengthening of the healthcare system, strengthening and revamping the educational system, improvement of the infrastructural facilities, consolidation of the benefits derived out of various programs already implemented.       Project Background Project cost tentatively worked out based on the details of total population, per capital expenditure, estimated number of people with HIV/AIDS, antiretroviral therapy to the patients, etc.  Cost of treatment The cost of treatment varies widely.  The pharmaceutical companies are willing to reduce the price for supplies to African countries.  According to SOS children, sponsoring a child requires a minimum of £20 per month. In antiretroviral therapy, first-line drug regimen is zidovudine + lamivudine + nevirapine. The average annual cost of the first-line regimen in the private sector is about US$ 1200 per person per year (World Health Organization 2005) Limitations  In working out the cost of treatment and the project cost there are many intangibles and assumptions.  Moreover, it varies widely from country to county, and involves lot of bargaining in some cases. Project Cost  Taking into account the willingness of the pharmaceutical companies to reduce the prices of the medicines, additional provision towards prevention and other overheads, the total project cost works out to around USD 1,100 million.  Though the project cost appears to be ambitious, due to the technological developments and the willingness on the part of the pharmaceutical giants, it could be concluded that the project is feasible and viable. The medical infrastructure required to manage AIDS has now been simplified; after the first several weeks, only 2-4 blood tests per year are required for monitoring. Adherence to medications (two pills, one each in the morning and evening) has been shown to be as good in poor countries as rich ones. Options  Regular supply of medicine is important for the success of the program. The pharmaceutical companies may be approached with long term supply agreement to cover the entire period of the project, with year wise break-up and suitable clauses for escalation.  Various national and international banks and financing agencies may be persuaded to extend long term loans based on the orders placed on the suppliers.  The pharmaceutical companies would like to come out with affordable rates in view of long term commitment to production and sales. These companies may also be encouraged to set up research projects in the AIDS affected countries for the effective study and research of the problem.  Since there are a number of small, big, governmental, NGOs and private corporate bodies involved in this national task, for the effective utilization of the resources, proper coordination among these agencies should be established to avoid duplication and overlapping of the services, which will reduce administrative costs.   Area wise or service wise allocation may be introduced with reference to the services, organizations and responsibilities. In the case of employment, appointment of locals over foreigners has distinct advantages, with regard to cost, service potential, long-term effect, communication and commitment.  Development of local talents available within the country will be useful for the development of the country in the long run.  In view of the economic potential of the country, corporate bodies of the developed world could be encouraged by international banks and finance institutions.   D. Soggy (2009) states ‘hydrocarbon sector currently absorbs around three-quarters of all investment but generates only a fraction of one percent of all new employment. By contrast, the agricultural sector absorbs less than one percent of recorded new investment18 but could generate massive new employment.’ signals the scope for foreign direct investment in the country.     Selected success stories  The international charitable organizations engaged in the HIV/AIDS program have contributed significantly to stem the tide of the disease reasonably.                      SOS Children Villalges ‘SOS Children is working in Benguela and Lubango, two towns in south-western Angola, and is reaching out to AIDS orphans and other vulnerable children and their families in the local communities. Over 630 people in 140 families receive the support.  Over 630 people in 140 families receive the support. The initiative has been considered as success on several grounds.                   Avert an international AIDS charity claims ‘Our HIV and AIDS projects have a particular emphasis on sustainable, cost-effective community responses to HIV & AIDS. Each HIV and AIDS project is developed and run according to the specific needs of the area by people who are local to the area.’  USAID (2010) stated, ‘Involvement of public in the program, and their active participation ensures success of the programs,’ and published several success stories. Evaluation of alternative options  An arrangement or agreement with the smaller organizations can be made to effectively utilize their resources for mutual benefit.  The overhead cost is saved on account of this synergy effectively.  Instead of appointing full time staff from foreign countries locals could be appointed for better coordination.  It will be better, if social workers are enrolled for this purpose or part time employment is offered to the teachers and retired person, because they understand the community better and communicate with them clearly The educational institutions in the country can be encouraged to send their students for project works, case studies, research, survey, etc. to the AIDS affected areas.  The options with regard to start up of new industries in the country could be explored in coordination with the international banks and financial institutions with the view of tapping new long term source of funds and support from the industries and business, with the help and assistance of the government, by way of concessions in tax, allocation of lands, etc. Regulation of the HIV/AIDS through Legislation  Since more and more resources and manpower are devoted to various HIV/AIDS programs, the government should exercise proper control by establishing lines of authority, fixing responsibilities and sanctioning of the expenditure incurred on various projects by it.  The government should pass suitable legislations in consultation with various agencies involved in the programs, because strict monitoring of the procedures and adherence to the time schedules, and adoption of proper methods are all important for the successful implementation of the project and achievement of the goals.  Recommendations  When there are many projects vying with each other for attention, the scarce resources move towards the projects where the rate of success is assured to a greater extent.  The success of the project depends upon the selection of the country.  Angola is now in strong foot more than ever before and there is political stability, with a strong army in the region.  Big oil companies of the world have presence and are in expansion mode in Angola. Diamond mining and trading are back in operation.  The farm lands of the country are fertile.  The country is also endowed with natural resources such as iron, granites, marbles, etc, though these industries are languishing for the time being. We divide this portion, ‘recommendations’ into strategy specific and project specific. Strategy specific The project could explore the possibilities of leveraging corporate philanthropy to its advantage.  A county with natural resources such as Angola would view corporate philanthropy with suspicion.  However, if it is handled by a non governmental development agency and the role of the corporate is restricted to donations, it could be viewed favorably by the government.  Long term supply contracts spreading over more than 20 years, for the supply of medicines and equipments for the project may be used for securing the supplies at lower rates.   Financial assistance to the suppliers for research and development or for new plants could be tied up with the international banks or financial institutions, based on the long term orders placed.  The government may be persuaded to encourage such pharmaceutical companies to set up their research projects in the country. Discussions should be initiated for the equitable sharing of the project costs with the government, United Nations, reputed corporate sponsors (corporate philanthropy).  Even when there is reluctance on the part of the participants, realizing their responsibility in this huge task, they will at least come out with some concessions. Project specific   Working towards collaboration with the other charitable organizations or Development agencies Recruitment of local talent  Appointment of part time employees from the local area Development of social work groups locally Giving training to the employees and social workers Distribution of pamphlets, brochures, notices to create public awareness Regular meetings with the work group to apprise them of the latest information & developments to motivate them Continuous training and upgrading of knowledge Forming subgroups or subcommittees for allocation of the responsibilities with regard to supply chain management, maintenance of the facilities, distribution & use of medicines, periodical health checkups and vaccinations for children Children are the important component of the scheme.  Ultimately, these children will become the teachers and educate their parents.  The children who are able to understand and who are able to communicate properly are all eligible to become a member and grouped under the senior or college students/ Teachers act as a link to so many groups in society.  Non monetary considerations such as small presents, invitations to parties, etc. should be properly planned to encourage them. The list of recommendations is not exhaustive.  The imagination, intuition and dedication of the organizers at various levels are very important for the success of the project. Bibliography        01.  Avert AIDS Charity (2010) ‘Avert’s HIV & AIDS Projects’ [ http://www.avert.org/aids-projects.htm] Accessed 25 March 2010. 02.  Avert AIDS Charity (2010) ‘Sub Saharan Africa HIV and AIDS Statistics’ [ www.avert.org/subaadults.htm] Accessed 24 March 2010. 03. BAXEN, J., & BREIDLID, A. (2009). ‘HIV/AIDS in Sub-Saharan Africa: understanding the implications of culture & context’. Cape Town, South Africa, UCT Press. 04.  Constructora Odebrecht (2010) ‘Odebrecht, Angola’.  [http://www.ifc.org/ifcext/aids.nsf/Content/Odebrecht_Angola] Accessed 24 March 2010.    05.  CRS issue of brief for US Congress (2003), AIDS in Africa 06.  The Drew Center for AIDS Research, Education and Services (Drew CARES) ‘Projects in Angola’  Charles Drew University of Medicine and Science [http://www.cdrewu.edu/research/drew_cares/international-programs] Accessed 25 March 2010 07.  J. Hopps (2009), ‘Stepping Up the Fight Against AIDS’[http://www.ifc.org/ifcext/africa.nsf/Content/HIVAIDSstory ] Accessed 24 March 2010.    08.  NCATA (2001) ‘Aids in Africa’ [http://www.scn.org/ncata/issue.html Accessed 25 March 201008.  09. D. Soggy (2009)  ‘Angola failed, yet successful, April 2009’ [http://www.fride.org ] Accessed 25 March 2010             10. Patterson, Amy S. 2005. ‘The African state and the AIDS crisis.’ Global health. Burlington, Vt: Ashgate. 11.  SOS  Children’s Villages (2010)  ‘Angola: African Beauty and Tragedy’. [www.soschildrensvillages.org.uk/aids-africa/projects-by-country/aids-angola-africa] Accessed 24 March 2010.    12. SOS  Children’s Villages (2010)  ‘Sponsoring a child’ [http://www.sponsorachild.org.uk/different-uk-child-sponsor-charities] Accessed 25 March 2010.                          13.  United Nations Development Program (2007) ‘HIV/AIDS Project’ [http:// www.ao.undp.org/HIV%20Project.htm] Accessed 24 March 2010 14.  USAID (2003) ‘Rainbow Nation Sows Seeds of Hope and Changes the Face of Farming’ [http://africastories.usaid.gov/search_details.cfm?storyID=158&countryID=24§orID=0&yearID=3] 15.  USAID (2005)‘SUCCESS STORY Indigenous Groups Address Women and AIDS Worldwide’ [http://www.usaid.gov] Accessed 25 March 2010]  Accessed 24 March 2010                              16.  USAID (2010) ‘Angola’. [ http://www.usaid.gov/locations/sub-saharan_africa/countries/angola] Accessed 24 March 2010.      17.  World Food Programme (2009) [http:// www.wfp.org/countries/angola] Accessed  24 March 2010.      Appendices   Table I Sub Saharan Africa HIV and AIDS Statistics Country People living with HIV/AIDS  Adult (15-49) rate % Women with HIV/AIDS Children with HIV/AIDS AIDS deaths Orphans        due to AIDS Angola 190,000 2.1 110,000 17,000 11,000 50,000 Benin 64,000 1.2 37,000 5,400 3,300 29,000 Botswana 300,000 23.9 170,000 15,000 11,000 95,000 Burkina Faso 130,000 1.6 61,000 10,000 9,200 100,000 Burundi 110,000 2.0 53,000 15,000 11,000 120,000 Cameroon 540,000 5.1 300,000 45,000 39,000 300,000 Central African Republic 160,000 6.3 91,000 14,000 11,000 72,000 Chad 200,000 3.5 110,000 19,000 14,000 85,000 Comoros Read More